Impact of zero-contrast percutaneous coronary intervention on renal function in chronic phase

Background Some studies have demonstrated zero or mini-contrast percutaneous coronary intervention (PCI) prevents contrast-associated acute kidney injury however those effect on chronic phase is unknown. This study addressed the impact of zero-contrast PCI on renal function after one-year. Methods A total of 2279 patients underwent PCI in our center from 2015 to 2022. Elective zero-contrast PCI was attempted for patients with chronic coronary syndrome and advanced CKD (stage 4, 5), and recommended for those with CKD (stage 3). Of 179 patients, serial data of creatinine between before and one-year after PCI was available in 134 patients. Zero-contrast PCI was defined as PCI without contrast until the final assessment of procedure. The primary endpoint was the variation of serum creatinine levels during one year. Results Renal function improved in 47 patients (35 %) with decrease of serum creatinine levels 0.22 (0.03 - 0.85) while it worsened in 87 patients (65 %) with increase 0.33 (0.02 - 2.33). After adjustment for variables including age, gender, conventional risk factors and examinations, hypertension [β -0.24, p = 0.01], baseline creatinine [β 0.67, p < 0.01], and increase of left ventricular ejection fraction [β -0.16, p = 0.04] were associated with the variation of serum creatinine levels. Conclusions Renal function improved in 35 % of CKD patients one-year after zero-contrast PCI. Higher baseline creatine level was negative and the improvement of cardiac function and history of hypertension (probably related to etiology of CKD) were positive factors.